Welcome to the latest installment of “Over 90 Percent of What Planned Parenthood Does,” a series on Planned Parenthood Advocates of Arizona’s blog that highlights Planned Parenthood’s diverse array of services — the ones Jon Kyl doesn’t know about.

When talking about Pap tests — particularly when discussing abnormal Pap results — one procedure that comes up a lot is the colposcopy.

It can sound intimidating and clinical on its own. And if you’re anything like me, you may have — ahem — occasionally confused it with the significantly more internal colonoscopy. For the sake of everyone’s anxiety levels, it may be best to set the record straight.

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What is a colposcopy, and what should you expect from the procedure?

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Why am I getting a colposcopy?

The most common reason for undergoing a colposcopy is having an abnormal Pap test result, particularly one that, when tested for DNA of human papillomavirus, yielded a positive result. Effectively, there are some abnormal cervical cells with HPV present. Because this could potentially progress to cervical cancer down the line, this combination makes health care providers want to get a closer look at what’s going on.

That said, colposcopies are sometimes performed for other reasons, such as genital warts on the cervix, cervicitis (inflamed cervix), or benign cervical polyps.

What does a colposcopy do exactly?

A colposcope, used to perform a colposcopy, basically looks like a pair of binoculars on a stand:

A colposcope — Image by S. Kellam, released into the public domain and obtained via Wikimedia Commons.

A colposcopy, then, uses a colposcope to get a better view of abnormal cervical cells than a health care provider could obtain via unaided visual examination or a Pap test.

Depending on what the provider sees during the colposcopy, a cervical biopsy or endocervical curettage might also be performed. Both procedures involve removing small amounts of potentially abnormal cervical tissue and sending the samples to a pathology lab.

How should I prepare for my colposcopy?

While most colposcopies are done in a standard doctor’s office, you may be referred to another provider — often a specialist who has a colposcope in their office — for the procedure. At present, Planned Parenthood Arizona is able to provide colposcopies at three of its health centers — in Flagstaff, Central Phoenix, and Tucson — with hopes to expand service locations in the coming year.

Planned Parenthood advises scheduling the procedure for a time when the patient isn’t expecting to be on their period. They also recommend that colposcopy patients refrain from douching, using tampons or penetrative sex toys, putting medications in their vaginas, or having vaginal intercourse for at least 24 hours before the procedure. It can also be a good idea to take an over-the-counter pain reliever about an hour prior to the procedure, particularly if a biopsy is scheduled.

What happens during the procedure?

The first part of a colposcopy is similar to a pelvic exam. The patient lies on the examining table, usually with their feet in stirrups or on other supports. A health care provider will insert a speculum into the vagina so that the cervix is easily visible.

Next, the provider applies a solution to the cervix and vaginal walls. This solution both clears away mucus and also turns any abnormal cells white, which makes them easier to see. Some people report a mild burning from this solution.

After that, the provider places the colposcope right next to the vaginal opening — but still outside the vagina. From there, the provider will examine the cervix for any abnormal cells.

At that point, if the procedure will include a biopsy or endocervical curettage, this is the point at which one will be performed. A punch biopsy involves taking a thin sample of cervical tissue about 3 to 4 millimeters in length while an endocervical curettage involves inserting a small scooplike instrument into the cervix to collect some of the cells inside. After the biopsy, the provider may apply a solution to help stop any bleeding.

From start to finish, the procedure usually takes between 10 and 20 minutes.

Will it hurt?

Pain is an individual thing, so the safest answer is — maybe, though most reports of pain or discomfort suggest that, if such pain is felt, it’s usually fairly mild.

As previously mentioned, during a colposcopy, the doctor will probably use a speculum to hold open the vaginal walls. This generally involves a feeling of pressure, which does end up being uncomfortable or painful to some people. Additionally, the vinegarlike solution used to prepare the vagina and cervix may burn or sting a little. Finally, if a biopsy is performed, it may feel like a momentary sharp pinch or menstrual cramp.

What risks are associated with colposcopies?

Overall, colposcopies — with or without biopsies — are very safe procedures, and the risks associated with them are rare. That said, those rare risks include infection and bleeding heavily enough to require treatment. According to Planned Parenthood, symptoms that require a call to a health care provider include:

• heavy bleeding (the American Congress of Obstetricians and Gynecologists quantifies this as using more than one sanitary pad per hour)
• abnormally heavy, yellow, or foul-smelling vaginal discharge (aside from the normal after-colposcopy discharge outlined below)
• fever
• chills
• severe abdominal pain

Aside from that, as with any medical test, there’s a risk that a colposcopy and/or biopsy could yield a false result (either negative or positive).

Though colposcopy during pregnancy is safe, some providers recommend delaying further testing until after the birth, especially if a biopsy is indicated. According to the American Journal of Obstetrics and Gynecology, one type of biopsy — endocervical curettage — is considered unacceptable during pregnancy due to the risk of premature membrane rupture.

What side effects can I expect after the procedure?

For a colposcopy without biopsy, there should be little to no discomfort as well as little to no bleeding (spotting only, if anything). Regular activities — including tampon use and all forms of sex, if applicable — can resume right away.

For a colposcopy with biopsy, it’s fairly common to have vaginal pain or soreness lasting for a few days after the procedure, as well as some bleeding for the same amount of time. It’s also normal to have dark vaginal discharge that may look like coffee grounds: This is the solution that was applied to stop the bleeding. It’s advisable to refrain from inserting objects inside the vagina for a few days — including penetrative sex and, depending on the individual provider’s recommendations, tampons — to allow time for the cervix to heal.

I have my colposcopy results. Where do we go from here?

Essentially, this depends on what those results say. For results with lower grade changes — check here for what that means — careful monitoring (such as with repeat Pap tests and/or HPV DNA tests in 6 to 12 months) may be the recommended approach. Other higher grade changes may warrant a procedure, such as cryotherapy or a LEEP, to remove the abnormal cells.

If you have further questions about colposcopies or would like to make an appointment for your own colposcopy, you can contact your nearest Planned Parenthood health center for information about resources in your area.